Individual
MRS. MARTA MATEO FIALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2519 HUNTERS RUN WAY, WESTON, FL 33327-1436
(954) 882-5387
(786) 888-2887
Mailing address
15051 ROYAL OAKS LN, #703, NORTH MIAMI, FL 33181-2457
(954) 882-5387
(786) 888-2887
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
279-0006593
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2648014400
BUREAU OF WORKERS COMPENS
OH
01
—
2818468000
LEGACY INDENTIFER
PA
01
—
28184680000
LEGACY INDENTIFER
NJ
01
—
Q08426
BLUE CROSS BLUE SHEILD
MA
Enumeration date
08/26/2006
Last updated
03/25/2008
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